Finding Religion at the End of Life: Patients of Faith Seek Lifesaving Care

March 18, 2009

By JOSEPH BROWNSTEINABC News Medical Unit

Having entered hospice care, Ruth Holt, 81, said her faith will not motivate her to seek more aggressive treatment for her terminal colon cancer.

"I think I'm more realistic than that," Holt said. "I'm a firm believer. I'm a true Presbyterian. What is to be will be."

While most patients, religious or not, avoid aggressive end-of-life therapy to prolong their time on Earth, a new study shows that religious patients may seek it out at three times the rate of non-religious patients, a finding that leads some to question why doctors don't address the issue of religion with their patients more often, when it informs so many medical decisions, particularly in end-of-life care.

"We're a very religious country, and patients, when they get sick and when they're suffering, many of them turn to religious faith to make sense of their illness," said Dr. Harold Koenig, director and founder of the Center for the Study of Religion/Spirituality and Health at Duke University, who was not involved with this particular study, but has looked at the issue of doctor-patient religion discussions through his own research.

"This is just something that is totally ignored by the medical profession," he said. "When you try to tell [physicians] about it, there's very little interest."

Relying on Religion at End of Life

The new study, published in the Journal of the American Medical Association, was led by researchers from the Dana Farber Cancer Institute in Boston. Researchers used 45-minute surveys from 345 patients.

Patients were asked about how much they relied upon religion to cope with illness, and researchers found that nearly 80 percent used it at least a moderate amount.

Researchers separated positive religious coping ("seeking God's love") and negative religious coping ("wondering whether God has abandoned me") and found that the extent of positive religious coping was a good predictor of which patients would seek aggressive end-of-life care.

While patients who sought positive religious coping requested aggressive end-of-life care 13.6 percent of the time, those who were not as religious sought it out just 4.2 percent of the time.

"It seems like those patients ... they would hold on as long as possible to give God every opportunity to grant them a miracle and save them," said Holly Prigerson of the department of psycho-oncology and palliative care at Dana Farber.

In the end, she noted, aggressive care did not lead to a more pleasant end.

"We find that those who get more aggressive care have decrements in their quality of life," she said. "The more aggressive care did not predict survival differences."

Doctors and Patients Address Faith

While there is some concern about a reluctance among patients and doctors to discuss religious beliefs, Prigerson noted that for patients who are willing to talk about religion, the study does give some encouraging news.

"The take-home from this study is actually that doctors are highly responsive to patient preferences," she said. "Religious patients wanted more aggressive care ... and they got it."

That has not alleviated everyone's concerns, however.

Dr. Andrea Phelps, an internal medicine physician and another of the study's authors noted that the researchers separately asked patients if they felt their spiritual needs were supported by the medical system.

"To a huge extent, patients said no," she said. "Probably, they just weren't being addressed."